Presentation on theme: "Jeff Kaufhold, MD FACP Nephrology Associates of Dayton Oct 2013"— Presentation transcript:
1Jeff Kaufhold, MD FACP Nephrology Associates of Dayton Oct 2013 ICD 10 and NephrologyJeff Kaufhold, MD FACPNephrology Associates of DaytonOct 2013
2Make the Diagnosis of Kidney Disease CriteriaThe ICD9 Code for CKD is 585.x where x = stageThe ICD 9 Code for ARF is 584.9Decreased kidney functioneGFR of <60 ml/min/1.73 m2 for ≥ 3 monthsAbnormal urinalysis including the presence of proteinuria or hematuriaRequest a spot urine protein/creatinine ratio(Normal is <30 mg/g)Document an abnormal Renal Imaging StudyBased on the KDOQI guidelines there are specific findings to make the diagnosis of CKD and this information will be helpful in assessing the need for Timely Referral.
3ICD 9 and 10 history ICD 9 developed by WHO ICD 9 Clinical Modification developed for US in 1979.CPT (clinical Procedural Terminology) codes used for ambulatory reporting.ICD 10 developed in 1990’sICD 10 codes are now available in EPIC as of OctMandatory use of ICD 10 is Oct 1, 2014.CPT codes will continue to be used for physician practice settings/ office billing
4ICD 10 after Oct 1 2014 Required for HIPAA transactions ICD 10 CM (Diagnosis) codes Required for diagnosis of all services inpt or outptICD 10 PCS (procedure) codes will be required on inpt claimsEPIC is starting the migration from ICD 9 to 10 codes now, and EPIC Premier inpt billing function includes the new ICD 10 coding structure.
5ICD 10 ChangesOver 50% of new Dx are musculoskel, and 36 % are to distinguish R from L
6ICD 10 Changes Up to 7 characters Includes complication, severity, sequelae and other disease related parametersIncludes lateralityIncludes initial or subsequent encounter codeImproved consistency of terminologyCombination codes are common i.e DM 2, controlled with renal manifestationHas space holders for expansion
7ICD 10 PCS coding for inpts DB58ZXSectionBody systemRoot operationBody partApproachDevicequalifierMed/SurgGIExcisionEsophagusNatural opening, endoscopicNo device implantedDiagnosticICD 9 ; EGD with excisional biopsy,ICD 10 0DB58ZX Endoscopic esophageal excision via natural or artificial opening
8Most common issues in ICD 10 Laterality – as you code, EPIC will prompt you if right or left is requiredTrimester specificMany new orthopedic codesSpecificity is increased dramatically, so physician documentation must be more specific too.
9Top 5 Clinical Documentation Issues CHFSepsisRenal FailurePneumoniaRespiratory FailureDon’t use “Other” or accept a nonspecific diagnosis like DM, when a more specific term exists:“DM 2 controlled with renal manifestation”
10ICD 10 codesEpic is migrating codes so over next year you may search using known ICD 9 codesCan keep your PMHx and ongoing problem list NONSPECIFIC,But your visit diagnosis list must be as specific, detailed, and include as many modifiers/ comorbidities/severity codes as possible
11Common DiagnosesICD 9DM 2 no mention of controlled or complicationDM 1 with renal manifestationICD 10E11.65 DM 2 with hyperglycemiaE10.21 DM 1 with nephropathy ANDE10.65 DM1 with hyperglycemia
12Top 5 Clinical Documentation issues ConditionCommon issuesFinancial impactCHFAcute vs Chronic,systolic vs diastolicDRG 684 Renal failure without major complication or comorbiditySepsisSepsis, severe sepsis, SIRS, bacteremia$ 3609Renal FailureAcute vs chronicStage with RIFLE criteria or CKD stageWith ATN is importantDRG 682 renal failure with major complication and comorbidityPneumoniaCause / specific bacteriaAspiration, simple vs complex, laterality$ 9340Respiratory FailureAcute vs chronic, resp distress vs resp failure
13Quality Performance hinges on Documentation For inpts affects the hospital quality scoreFor our pts affects our practice scoreLack of clear documentation results in inappropriate assignment of complication codes for expected consequence of renal diseaseImproved documentation results in lower reported complication rates,higher complexity/ comorbidity scores reflect sicker population we care for.
14Specific details for pts with ARF and CKD DM Type I or II, controlled or uncontrolledUse A1c over 6.5 as uncontrolledWith renal manifestationHypertensionWith nephropathyCKD stages 1-5, use ESRD for pts on dialysis in the medicare ESRD program.AKI with ATN
15Specific details for pts with ARF and CKD AKI with ATNUrine findings ATN castsOliguriaCreatinine over 2.5 or > 2X baselineWere they pre-renal?Does pt have TIN?Complications of renal failureAnemia of CKDSecondary hyperparathyroidism of renal originProtein calorie malnutrition Severe = albumin less than 3.0
16Estimated impact on physician practice % increase in denialsDifferences in authorization and referral triggersIncreased scrutiny of documentationImpact on contracting/ preferred provider status based on severity of illness as reflected in coding.
17ICD 10 and EPICICD 10 diagnosis calculator goes live on Premier Epic OctTraining modules available on HealthstreamSome codes require specific information, and a coding window will open to fill in R vs L, initial visit vs followup, sequelae.Many codes won’t require more specificity, but for visits we should try to be as specific as possible.
18ICD 10 and EPICMany codes won’t require more specificity, but for visits we should try to be as specific as possible.We can double click item on the problem list like DM, HTN, Other disorder of renal etc, and make it more specific, without losing / deleting associations.
19Diabetes codesE DM due to underlying condition with diabetic nephropathyE Drug or chemical induced DM with DM CKDE DM I with Diab. NephE DM II with Diabetic NephropathyE13.22 Other specified DM with Diabetic CKD
21CKD and DM codes Code the DM first, then the stage: E10.22 Type I DM with nephropathyN18.6 ESRDSame for Hypertensive Kidney DiseaseI12 hypertensive Kidney diseaseN18.4 CKD Stage 4If pt has heart and kidney disease, useI13 hypertensive Heart and CKDCHF uses I 50 codes
22HTN and CKD Codes I12.0 Hypertensive CKD with Stage 5 or ESRD I12.9 “” “” with stages 1-4 CKDI Hypertensive Heart and CKD without heart failure, Stages 1-4I Hypertensive Heart and CKD without heart failure, Stage 5 or ESRDI13.2 Hypertensive Heart and CKD with heart failure, Stage 5 or ESRD
24Nephrology Codes PCKD Q 61.3 Acquired cyst N 28.1 Q Congenital Malformations of the urinary SystemR 80 ProteinuriaR 81 GlycosuriaR 60 EdemaICD10data.com
25Nephrology Codes for ICD 10 Electrolyte disorders: E 87High K E 87.5Protein Calorie MalnutritionE 43 severeE 44 Mild to ModerateSecondary hyperparathyroidism of renal originN 25.81
26Nephrology Common Codes Anemia of CKD D 63.1Lupus NephritisSLE M 32 – not completely mapped yetRenal transplant – has not yet mapped(as of Oct 2013)Dysfunction would be coded with the ARF or CKD code to denote pts renal function at time of visitN 17.9 ARFN 18.3 CKD stage 3
27Transplant SpecificsJust because your patient has a transplant, they still have Chronic Kidney disease.List the transplantList the CKD stage for chronic allograft dysfunctionList acute allograft dysfunction if presentList the cause of their underlying CKD/ESRDList comorbidities and complicationsAre they anemic due to Cellcept use?Did they develop NODAT?Doc talk, Precyse University, Oct 2013
28PCKD specifics PCKD Q 61.3 Acquired cyst N 28.1 Q Congenital Malformations of the urinary SystemAutosomal Dominant or recessive?Liver /other cysts?